5-Year results of postoperative extended-field irradiation on 76 patients with nodal metastases from cervical carcinoma stages IB to IIIB

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Abstract
Extended-field irradiation was administered after radical surgery to 76 patients with nodal metastases from cervical carcinoma Stages IB (37 patients), IIA (six patients), IIB (29 patients), and IIIB (four patients). The first recurrent sites of disease were distant organs via hematogenous routes of 12 patients and in the pelvic fields of eight patients. The 5-year disease-free survival rates were 95% for 27 patients with one positive node, 64% for 37 patients with multiple positive nodes, and 44% for 12 patients with unresectable nodes; 72% in total. Poor disease-free survival rates were associated with Stage IIB (60%), more than 30 mm invasion depths (44%), small cell cancer (0%), adenocarcinoma (57%), adenosquamous carcinoma (50%), and premenopause (60%). In 52 patients with nonkeratinizing large cell carcinoma, the disease-free survival rates were significantly different between Stage IB and IIB (87% versus 47%, P < 0.05). This dissimilarity was caused by significant differences between Stage IB and IIB patients with less than 30 mm invasion depths (90% versus 53%, P < 0.05), with parametrial extension (100% versus 39%, P < 0.005), and with unresectable nodes (100% versus 0%, P < 0.05). These results indicate that postoperative extended-field irradiation can control distant spread via lymphatic routes with significant improvement of patient survival, and that the number of positive nodes, tumor cell types, depth of tumor invasion, and clinical stages are important prognostic factors subsequent to this combined therapy.